This seminar work deals with the topic of evaluating the quality of ECG signals. The introductory chapters explain the basic characteristics of ECG signals - measurement, the form of the measured signal, methods of analysis. The cardiac physiology and pathology is presented. The most common types of noise that occur in ECG signals are also mentioned. Further, the reader is acquainted with the importance of the issue of evaluating the quality of ECG signals. In the practical part of the work, two own methods for ECG quality evaluation are presented. First, a brief theoretical introduction to the techniques used in the creation of methoda is given, followed by a description of the principle of algorithms. In order to compare the functionality of the proposed methods, three more methods from other authors are presented. Their principle is briefly described. In the final chapter, all methods are subjected to functionality testing. The results are examined and all methods are compared with each other.

This master's thesis deals with an analysis of principles of ECG signals detection and delineation. The theoretical part describes heart electrophysiology and electrocardiography basics. Next, the most important QRS detection and ECG delineation algorithms are introduced. Especially the wavelet transform methods are described. In the practical part proper delineation algoriythm was realized. It was tested on the standard CSE database, then it was modified on data of isolated rabbit heartsand the results are published in the conclusion.

This master's thesis describes basics principles of QRS complex detection. It is focused on QRS detection using zero crossing counts method. There are described princips and program realization of this method. The other part is focused on genetic optimalization algorithm. There are presented obtained optimalization results on standard CSE and MIT-BIH database. The quality of the detector is compared with other authors. The optimalized QRS detector achieves comparable results with other authors. The part of the thesis is graphical user interface which supply view on modified ECG signal and detection results.

Electrical impedance of biological matter is known as electrical bio-impedance or simply as bio-impedance. Bio-impedance devices are of great value for monitoring the pathological and physiological status of biological tissues in clinical and home environments. The technological progress in instrumentation has significantly contributed to the progress that has been observed during the last past decades in impedance spectroscopy and electrical impedance cardiograph. Although bio-impedance is not a physiological parameter, the method enables tissue characterization and functional monitoring and can contribute to the monitoring of the health status of a person. In this paper an inexpensive portable multi frequency impedance cardiograph device based on impedance spectroscopy technique has been developed. By means of this system the basic thoracic impedance range and the heart-action-caused changes of impedance can be measured and the hemodynamic parameters of the heart function can be determined. This system has small size and low current consumption. The impedance cardiograph signals of the electrodes configuration by Sramek, Penney and Qu in this work was measured; compared and summarized. The differences of the measuring method, the schematic circuit diagram, the measurement results and area of application between impedance cardiograph and impedance spectroscopy were discussed and compared. The performance of this sensor-system was evaluated.

As the world population ages, the healthcare system is facing new challenges in treating more patients at a lower cost than today. One trend in addressing this problem is to increase the opportunities of in-home care. To achieve this there is a need for safe and cost-effective monitoring systems. Biosignal PI is an ongoing open-source project created to develop a flexible and affordable platform for development of stand-alone devices able to measure and process physiological signals. This master thesis project, performed at the department of Medical Sensors, Signals and System at the School of Technology and Health, aimed at further develop the Biosignal PI software by constructing a new flexible software framework architecture that could be used for measurement and processing of different types of biosignals. The project also aimed at implementing features for Heart Rate Variability(HRV) Analysis in the Biosignal PI software as well as developing a graphical user interface(GUI) for the Raspberry PI hardware module PiFace Control and Display. The project developed a new flexible abstract software framework for the Biosignal PI. The new framework was constructed to abstract all hardware specifics into smaller interchangeable modules, with the idea of the modules being independent in handling their specific task making it possible to make changes in the Biosignal PI software without having to rewrite all of the core. The new developed Biosignal PI software framework was implemented into the existing hardware setup consisting of an Raspberry PI, a small and affordable single-board computer, connected to ADAS1000, a low power analog front end capable of recording an Electrocardiography(ECG). To control the Biosignal PI software two different GUIs were implemented. One GUI extending the original software GUI with the added feature of making it able to perform HRV-Analysis on the Raspberry PI. This GUI requires a mouse and computer screen to function. To be able to control the Biosignal PI without mouse the project also created a GUI for the PiFace Control and Display. The PiFace GUI enables the user to collect and store ECG signals without the need of an big computer screen, increasing the mobility of the Biosignal PI device.   To help with the development process and also to make the project more compliant with the Medical Device Directive a couple of development tools were implemented such as a CMake build system, integrating the project with the Googletest testing framework for automated testing and the implementation of the document generator software Doxygen to be able to create an Software Documentation.    The Biosignal PI software developed in this thesis is available through Github at https://github.com/biosignalpi/Version-A1-Rapsberry-PI / Allt eftersom världens befolkning åldras, ställs sjukvården inför nya utmaningar i att behandla fler patienter till en lägre kostnad än idag. En trend för att lösa detta problem är att utöka möjligheterna till vård i hemmet.För att kunna göra detta finns det ett ökande behov av säkra och kostnadseffektiva patientövervakningssystem. Biosignal PI är ett pågående projekt med öppen källkod som skapats för att utveckla en flexibel och prisvärd plattform för utveckling av fristående enheter som kan mäta och bearbeta olika fysiologiska signaler. Detta examensarbete genomfördes vid institutionen för medicinska sensorer, signaler och system vid Skolan för Teknik och Hälsa. Projektet syftade till att vidareutveckla den befintliga mjukvaran för Biosignal PI genom att skapa ett nytt flexibelt mjukvaruramverk som kan användas för mätning och bearbetning av olika typer av biosignaler.Projektet syftade också till att utvidga mjukvaran och lägga till funktioner för att kunna genomföra hjärtfrekvensvariabilitets(HRV) analys i Biosignal PIs mjukvara, samt att utveckla ett grafiskt användargränssnitt(GUI) för hårdvarumodulen PiFace Control and Display. Projektet har utvecklat ett nytt flexibelt mjukvaruramverk för Biosignal PI. Det nya ramverket konstruerades för att abstrahera alla hårdvaruspecifika delar in i mindre utbytbara moduler, med tanken att modulerna ska vara oberoende i hur de hanterar sin specifika uppgift. På så sätt ska det vara möjligt att göra ändringar i Biosignal PIs programvara utan att behöva skriva om hela mjukvaran.Det nyutvecklade Biosignal PI ramverket implementerades i det befintliga hårdvaru systemet, som består av en Raspberry PI, liten och prisvärd enkortsdator, ansluten till ADAS1000, en analog hårdvarumodul med möjlighet att registrera ett elektrokardiografi(EKG/ECG). För att kontrollera Biosignal PI programmet har två olika grafiska användargränssnitt skapats.Det ena gränssnitt är en utvidgning av original programvaran med tillagd funktionalitet för att kunna göra HRV-Analys på Raspberry PI, detta gränssnitt kräver dock mus och dataskärm för att kunna användas.För att kunna styra Biosignal PI utan mus och skärm skapades det även ett gränssnitt för PiFace Control and Display. PiFace gränssnittet gör det möjligt för användaren att samla in och lagra EKG-signaler utan att behöva en stor datorskärm, på så sätt kan man öka Biosignal PI systemets mobilitet. För att underlätta utvecklingsprocessen, samt göra projektet mer förenligt med det medicintekniska regelverket, har ett par utvecklingsverktyg integrerats till Biosignal PI projektet såsom CMake för kontroll av kompileringsprocessen, test ramverket Googletest för automatiserad testning samt integrering med dokumentations generatorn Doxygen för att kunna skapa en dokumentation av mjukvaran.

Abstract Cardiovascular diseases are the leading cause of death in developed countries. Approximately 50% of these events are due to sudden cardiac death (SCD) and often without preceding diagnosis of cardiac disease. Many risk factors for cardiac events have been identified and prevention strategies have improved markedly. The aim of this thesis was to evaluate the usability of the 12-lead electrocardiogram (ECG) to predict cardiac events. The study population consisted of 10,904 middle-aged general population subjects with ECG recordings between the years 1966–1972 with a long follow-up (30±11 years). The first part of the thesis (I) focused on the prevalence and prognostic significance of fragmented QRS complex (fQRS). The prevalence of fQRS was 19.7%. Fragmented QRS complex did not predict mortality in subjects with no history of cardiac disease. Among subjects with underlying cardiac disease and lateral fQRS, the risk of cardiac death was 2.5-fold (P=0.001) and the risk of SCD was almost 3-fold (P=0.004). Other major electrocardiographic abnormalities were assessed in subjects without known cardiac disease for the risk of cardiac death, SCD and hospitalization due to coronary artery disease (II, III). Abnormal ECG was moderately associated with cardiac death after 10 and 30 years of follow-up (hazard ratio 1.7, P=0.009; hazard ratio 1.3, P>0.001, respectively) (II). The risk of hospitalization was not associated with abnormal ECG findings. Abnormal ECG moderately predicted SCD during 10 and 30 years of follow-up (hazard ratio 1.6, P=0.052; hazard ratio 1.3, P=0.007) (III). The risk of SCD was 3-fold when ≥2 ECG abnormalities were present. In conclusion, lateral fQRS in middle-aged subjects with underlying cardiac disease was associated with increased risk of death. Certain abnormal ECG findings associated with the risk of non-arrhythmic cardiac mortality and arrhythmic death. The risk of arrhythmic mortality was substantially elevated when multiple ECG abnormalities were present in middle-aged population. / Tiivistelmä Sydänsairaudet ovat yleisin kuolinsyy kehittyneissä maissa. Noin 50 % näistä kuolemista aiheutuu äkillisestä sydänpysähdyksestä, suuri osa ilman aiempaa tietoa sairaudesta. Useita sydänsairauksien riskitekijöitä on tunnistettu ja ennaltaehkäisy on kehittynyt merkittävästi. Väitöstutkimuksen tavoitteena on tutkia 12-kytkentäisen sydänsähkökäyrän (EKG) käyttökelpoisuutta sydänsairauksien ilmenemisen ennustamisessa. Tutkimusväestöön kuului 10,904 keski-ikäistä suomalaista henkilöä. Aineisto kerättiin vuosina 1966-1972 ja seuranta-aika oli 30 (±11) vuotta. Ensimmäisessä osajulkaisussa (I) tutkimme QRS-kompleksin fragmentaation vallitsevuutta ja sen vaikutusta ennusteeseen väestössä. Fragmentoituneen QRS-kompleksin esiintyvyys oli 19.7 %. Fragmentoitunut QRS-kompleksi ei lisännyt kuolemanriskiä henkilöillä, joilla ei ollut sydänsairautta. Henkilöillä, joilla oli todettu sydänsairaus, lateraalinen fQRS lisäsi sydänperäistä kuolleisuutta 2.5-kertaiseksi (P=0.001) ja rytmihäiriöperäistä kuolleisuutta 3-kertaiseksi (P=0.004). Tutkimme muiden poikkeavien EKG-löydösten ennustearvoa kuolleisuuteen ja sairaalahoidon tarpeeseen sepelvaltimokohtauksen vuoksi (II, III). Poikkeavien EKG-muutosten esiintymiseen liittyi lisääntyneen sydänperäisen kuoleman riski sekä 10 vuoden (riskitiheyssuhde 1.7, P=0.009) että 30 vuoden seurannassa (riskitiheyssuhde 1.3, P>0.001) (II). Poikkeavat EKG-muutokset eivät ennustaneet sairaalahoitojaksoja. Poikkeava EKG ennusti rytmihäiriöperäisen kuoleman riskiä sekä 10 vuoden (riskitiheyssuhde 1.6, P=0.052) että 30 vuoden seurannassa (riskitiheyssuhde 1.3, P=0.007) (III). Äkkikuoleman riski oli 3-kertainen henkilöillä, joilla todettiin ≥ 2 EKG-poikkeavuutta. Tutkimuksen yhteenvetona voidaan todeta, että fQRS lateraalisissa kytkennöissä lisäsi sydänperäisen kuoleman riskiä henkilöillä, joilla on todettu sydänsairaus. Tiettyihin poikkeaviin EKG-muutoksiin liittyi lisääntynyt ei-rytmihäiriöperäisen ja rytmihäiriöperäisen kuoleman riski. Useiden tutkittujen EKG-muutosten ilmentyminen samanaikaisesti lisäsi merkittävästi rytmihäiriöperäisen kuoleman riskiä keski-ikäisessä väestössä.

BACKGROUND: Right ventricular outflow tract (RVOT) is a common source of ventricular tachycardia, which often requires ablation. However, the mechanisms underlying the RVOT's unique arrhythmia susceptibility remain poorly understood due to lack of detailed electrophysiological and molecular studies of the human RVOT. METHODS: We conducted optical mapping studies in 16 nondiseased donor human RVOT preparations subjected to pharmacologically induced adrenergic and cholinergic stimulation to evaluate susceptibility to arrhythmias and characterize arrhythmia dynamics. RESULTS: We found that under control conditions, RVOT has shorter action potential duration at 80% repolarization relative to the right ventricular apical region. Treatment with isoproterenol (100 nM) shortened action potential duration at 80% repolarization and increased incidence of premature ventricular contractions (=0.003), whereas acetylcholine (100 μM) stimulation alone had no effect on action potential duration at 80% repolarization or premature ventricular contractions. However, acetylcholine treatment after isoproterenol stimulation reduced the incidence of premature ventricular contractions (=0.034) and partially reversed action potential duration at 80% repolarization shortening (=0.029). Immunolabeling of RVOT (n=4) confirmed the presence of cholinergic marker VAChT (vesicular acetylcholine transporter) in the region. Rapid pacing revealed RVOT susceptibility to both concordant and discordant alternans. Investigation into transmural arrhythmia dynamics showed that arrhythmia wave fronts and phase singularities (rotors) were relatively more organized in the endocardium than in the epicardium (=0.006). Moreover, there was a weak but positive spatiotemporal autocorrelation between epicardial and endocardial arrhythmic wave fronts and rotors. Transcriptome analysis (n=10 hearts) suggests a trend that MAPK (mitogen-activated protein kinase) signaling, calcium signaling, and cGMP-PKG (protein kinase G) signaling are among the pathways that may be enriched in the male RVOT, whereas pathways of neurodegeneration may be enriched in the female RVOT. CONCLUSIONS: Human RVOT electrophysiology is characterized by shorter action potential duration relative to the right ventricular apical region. Cholinergic right ventricular stimulation attenuates the arrhythmogenic effects of adrenergic stimulation, including increase in frequency of premature ventricular contractions and shortening of wavelength. Right ventricular arrhythmia is characterized by positive spatial-temporal autocorrelation between epicardial-endocardial arrhythmic wave fronts and rotors that are relatively more organized in the endocardium.

Obstructive sleep apnea (OSA) occurs commonly in the U.S. population and is seen in both obese as well as non-obese individuals. OSA is a disease characterized by periodic upper airway collapse during sleep, which then results in either apnea, hypopnea, or both. The disorder leads to a variety of medical complications. Neuropsychiatric complications include daytime somnolence, cognitive dysfunction, and depression. Increased incidence of motor vehicle accidents has been documented in these patients and probably reflects disordered reflex mechanisms or excessive somnolence. More importantly, vascular disorders such as hypertension, stroke, congestive cardiac failure, arrhythmias, and atherosclerosis occur frequently in these patients. The lungs may be affected by pulmonary hypertension and worsening of asthma. Recent data from several laboratories demonstrate that obstructive sleep apnea is characterized by an inflammatory response. Cytokines are elaborated during the hypoxemic episodes leading to inflammatory responses as marked clinically by elevated C-reactive protein (CRP). As elevated CRP levels are considered markers of the acute phase response and characterize progression of vascular injury in coronary artery disease, it is likely that obstructive sleep apnea could lead to worsening of vasculopathy. Moreover, as inflammatory mechanisms regulate bronchial asthma, it is also likely that cytokines and superoxide radicals generated during hypoxemic episodes could exacerbate reactive airway disease. Patients with Cough, Obstructive sleep apnea, Rhinosinusitis, and Esophageal reflux clustered together can be categorized by the acronym, "CORE", syndrome. The purpose of this manuscript is to review the inflammatory responses that occur in patients with obstructive sleep apnea and relate them to the occurrence of cardiopulmonary disease.

No description available.

L'objectif de cette thèse est de concevoir une architecture de services Web pour la dé-termination automatique d’un système de capteurs personnalisé, embarqué sous forme de vêtement intelligent dédié au self-care, afin de permettre à tout utilisateur profane d'enregistrer lui-même son propre électrocardiogramme (ECG), à tout moment et n’importe où. Le défi principal réside dans l'orchestration intelligente et dynamique de services métiers en fonction du contexte, pour qu’ils fournissent à l'utilisateur une solution personnalisée optimale tout en maîtrisant la complexité inhérente à la dépendance au contexte des interactions homme-machine, à l'extraction des connaissances des signes vitaux spécifiques à un sujet, et à l'automatisation de la reconfiguration des services. Une solution à ce défi est de créer une intelligence ambiante qui étend la notion d'informatique ubiquitaire et est capable d’offrir à l’instar d’un expert du domaine, une assistance intelligente personnalisée à tout citoyen. Nous proposons une méthodologie de construction d'une architecture DM-SOA orientée-services, dirigée à la fois par les données et par des modèles, pour la production de services métiers intelligents et tenant compte du contexte. Cette architecture permet l’automatisation d’activités sophistiquées et personnalisées qu’un expert mettrait en œuvre pour le traitement d’un cas individuel, à partir de ses connaissances professionnelles. La solution proposée est basée sur une nouvelle approche de modélisation dynamique de processus métiers, et l’implémentation de services reconfigurables automatiquement. Elle consiste à mettre en œuvre un environnement intelligent fondé sur une ontologie de processus métiers des concepts du domaine et de son contexte, et sur une base de règles pour l'orchestration contextuelle des services. Pour valider le bien-fondé de notre approche, nous avons proposé une ontologie pour l’automatisation de processus d’aide à la décision et nous l’avons évaluée dans le domaine de la cardiologie, en l’appliquant au problème de la sélection la plus adéquate possible d’un système de positionnement d’électrodes, spécifique à chaque individu, et capable de fournir un signal ECG de contenu diagnostique similaire à celui d'un ECG standard à 12 dérivations. Pour répondre aux besoins en situation de self-care tout en préservant la qualité diagnostique des signaux enregistrés à la demande, nous proposons la réalisation d’un nouveau système prototype de capture ECG-3D à trois modalités. Ce prototype a été testé sur huit jeunes adultes volontaires sains (4 hommes et 4 femmes) présentant diverses caractéristiques morphologiques. L'intelligence ambiante est fournie par un ensemble de services de qualité professionnelle, prêts à l’emploi par des utilisateurs profanes. Ces services peuvent être accessibles au travail, n’importe où, via des moyens classiquement utilisés chaque jour, et fournissent une aide appropriée aux utilisateurs non-compétents. / The aim of the thesis is to design a web services architecture that shall support the automatic determination of a personalised sensor-system, which is embedded in smart garments, and which shall be used in self-care in order to allow a profane user to record himself a personal electrocardiogram (ECG), at anytime and anywhere. The main challenge consists in the intelligent and dynamic orchestration of context-aware business services that supply the user with an optimal personalised solution, while mastering the system’s complexity: context dependent user and system interactions, knowledge extraction from subject-specific vital signs, services reconfiguration automation. The solution to this challenge is to create an Ambient Intelligence which goes beyond Ubiquitous Computing and is capable to replace an expert by proposing an Intelligent Assistance to any citizen. We propose a methodology expressed in terms of Data and Model driven Service Oriented Architecture (DM-SOA), which provides a framework for the production of context-aware intelligent business services. This architecture supports the automation of sophisticated and personalised expert activities, which apply professional knowledge to process an individual case. The proposed solution is based on a new dynamic business process modelling approach and in its implementation via automatically reconfigurable services. It consists in setting-up an intelligent environment based on a business process ontology of context-aware concepts and on related context handling rules for services orchestration. A core-ontology has been designed to support the automation of expert activities related to decision-making. The soundness of the method and of the underlying decision-making techniques has been demonstrated in the cardiology domain for selecting the most adequate subject-specific sensor-system, characterised by its ability to yield for an ECG signal of similar diagnostic content than a standard 12-lead ECG. We propose the design of a new three modalities sensor-system prototype as a response to the need of sensor-systems used on demand in self-care situations and ensuring diagnostic quality signals recordings. This prototype has been tested on a set of healthy volunteers presenting various characteristics in age, sex and morphology. In this context, Ambient Intelligence is demonstrated as an ensemble of professional quality services ready to use by profane users. These services are accessible pervasively, trough the objects people work with / wear on / use each day, and provide an appropriate guidance to the non-competent users. Such an Ambient Intelligence approach strongly supports the vision of an Information Society which corresponds to the long-term goal of the EU Information Society Technologies Research Programme that aims to ease knowledge access. The future healthcare will benefit from this approach and will significantly improve patient care.